psuedo-science

Since the beginning of this school year I've been on-and-off sick. Swollen lymph nodes, sore throat, exhaustion, bruising, and a sporadic low fever. Nothing too significant, just mostly a mild generalized malaise. Being the second year med student that I am I have subsequently created quiet an impressive differential diagnosis: lymphoma, leukemia, pericarditis, GI cancer, malaria, etc... but really, it's none of these. I am sure of that. Likely it is just stress and a reoccurance of anemia (which I have a long history with).

I was at health services for something else this week and in talking with the doctor, we decided to draw some labs to see if we could find the culprit. I'm not entierly sure what she ordered but I think it included a CBC, mono titer, and maybe something else. For kicks, and because she was definitive that this is all because I'm a type 1 diabetic (don't get me started on how frustrating this encounter was), she also drew a hba1c.

My blood work came back without any significant findings. So still no explanation for the generalized annoyance my body is dealing with. I'm relieved it isn't mono and really not all that concerned. It is possible that the malaise is cause by simple seasonal allergies, for which I just began taking Claritin. I also expect my endocrinologist (who is also my PCP) will want a full iron panel when I see him in a few weeks.

The point of this post? To acknowledge that 2nd year med students are crazy. It isn't fully our fault; pathology is enough to make anyone into a hypochondriac. However, more important, I'm now running a sort of psuedo-science experiment. My a1c was 8.1. It's definitely not ideal but also not horrible... My experiment is to see if 1 month of wearing my continuous glucose monitoring sensor will have an impact on my blood sugar control. Since it's only a month, and an hba1c measures a 3 month average, the change probably wont be too significant either way. Results will be determined through comparison between this 8.1 and my a1c when I see my endo later this month. I'm hoping that thinking of it as an experiment will motivate me to continue wearing the sensor through the month (which I tend to find annoying and a little painful) and that it will prove helpful with my control. I need to start developing a better relationship with the CGMS as I expect that it will be my saving grace for clinical rotations.

specialty apptitude test

While procrastinating this week I took a specialty aptitude test. While I find the results to be interesting, and a good reminder that I have to excel on STEP 1* so that all options are open to me, I don't know how accurate it is. For one, I'm partially going into medicine to be trained as an abortion provider and only some of the specialties (highlighted below) will allow for that. It'll be interesting to see what clinical rotations bring and what I actually decide to go into....

Rank Specialty Score
1 thoracic surgery 42
2 occupational med 42
3 aerospace med 41
4 obstetrics/gynecology 41
5 pulmonology 41
6 nephrology 40
7 orthopaedic surgery 40
8 cardiology 40
9 physical med & rehabilitation 40
10 pathology 39
11 otolaryngology 39
12 preventive med 39
13 general surgery 39
14 rheumatology 39
15 hematology 39
16 infectious disease 38
17 urology 38
18 plastic surgery 38
19 pediatrics 37
20 nuclear med 37
21 neurology 37
22 neurosurgery 37
23 ophthalmology 37
24 med oncology 37
25 general internal med 37
26 family practice 37
27 endocrinology 37
28 radiation oncology 37
29 emergency med 36
30 radiology 36
31 psychiatry 35
32 dermatology 35
33 colon & rectal surgery 35
34 allergy & immunology 35
35 gastroenterology 35
36 anesthesiology 33

*STEP 1 is the big scary test that I have to take at the end of this year. The results will significantly impact my residency options. Reminders of how important the exam is are not necessary... it is something every medical student is well aware of.

marriage & chronic illness

At 16 years old, I was dumped by a girl I cared a lot about. Her reason for dumping me? She was scared of my insulin pump. This was the impetus for many hours of therapy sent mulling over how my chronic illness(es) effect my sexual attractiveness & hopes for future relationships.

In some ways I understand her apprehension, especially while a reckless teenager. I'd rather find out sooner rather than latter that someone can't handle my baggage. I also understand how my diseases play into a relationship: effecting what restaurants we can eat at, decreasing my ability to be spontaneous, low blood sugar and pulling out pump sites at the most inopportune of times, etc.... But the thing is, it's MY baggage. Sure, what diabetic doesn't love a significant other who will occasionally gets up in the middle of the night fetch juice for a low blood sugar? But I don't expect it.

Anyhow, today a friend sent me an article posted in The New York Jewish Week. Her e-mail was short and sweet:
"seems like something you would write.
http://www.thejewishweek.com/editorial_opinion/last_word/ms_mrs_hiding_plain_sight
love,---"
And the friend is right. The author's points are things that I agree with, and her fear of chronic disease sentencing her to a life of single-hood hits close to home. Pessimistically though, this is not something I imagine changing (in or out of the superstitious observant Jewish community) anytime soon. So instead I just hope that someday I will meet someone who wants to build a life with me regardless of my diabetes & celiac.

In which I become a...

cat owner/parent/stereotype/lesbian/[insert something else].


Meet Lulav!

I adopted him this past week and am already so in love! While I am by nature much more of a dog person than a cat person, my life is currently not compatible with being a dog owner. I spend way too many hours at school. My apartment is small. My clinical hours next year will be way too unpredictable. (Side note: a bunch of my classmates have adopted dogs. While I am in no place to judge their decision, I would love to know HOW they are doing it.) So anyhow I compromised my needs to become a parent, or at least get over my fear of commitment, and decided that I can offer a loving home to a kitty.

It is strange to think about how much Lulav will likely see me through. Becoming an MD, going through residency, likely moving houses/cities/states a few different times, and possibly even becoming a wife and having children. It has only been a few days, but I already have such love for a such a small little creature! Plus, he helps me study:

Checking things off the bucket list...

I can now check "selling myself" off of my bucket list. Maybe, if being generous, I can also check off "sex work"... but that would be pushing it.

Last night was the annual date auction fundraiser; a night that involves medical students and professors selling themselves in order to send a small group of students on a humanitarian medical mission. Turns out that I'm worth $80! Well, me and one of my friends (a fellow 2nd year med student) are worth that much. We got sold as a package deal: one-on-one sex ed from me and home backed cookies from her. Not too bad considering that most everyone went for between $40 and $100, though there were a few outliers going for $120 or so. I'm just REALLY relived that we sold at all as it would have been really embarrassing to stand up on stage and not be bid on.

In general, last night was not a night I will soon forget. The date auction was preceded by a madmen themed birthday party with good people and fun costumes. It isn't that common that I go to events with large amounts of drunk med students. It also isn't common that I get all femmed up to go out... and feel confident that I look hot. I always feel like it wont be my thing: too much alcohol and bad decision making, too late of a night out, too much photographic evidence to be posted on facebook, and too much drama that I would rather avoid. However, last night was actually fun. I was reminded that a lot of my classmates are genuinely good people and enjoyable to hang out with.

Plus there was a friend visiting one of the first years who also wears a pump. We totally geeked out on and flirted about the diabetes! We got into a pretty intense conversation about diabetes & drinking as well as about pump sites & body image issues. Both of which are conversations I will probably have with you, blog, in the future. Even tipsy, I can't escape my reality...

It gets better, part 2

This National Coming Out Day my heart hurts, a lot. It is 2010, why do we still tolerate hate and discrimination? It is time to seriously start changing this world. Watch this video. Sign this pledge. To all of you allies out there: start standing up for those of us who are LGBTQ; it gets lonely fighting this battle all on our own.

It gets better

Tomorrow is National Coming Out Day. It is a day that has never had meaning for me. I don't really understand having a single day with the mission of coming out, nor am I someone that revisits my own coming out story. However, in light of recent events, this year I feel a little different about it all. I walk a fine line with this blog in differentiating between professional and personal; I feel that it is important to be an advocate who leaves details of my own life out of the equation. After A LOT of thought, I have decided that this post is going to cross the line though. I'm going to share my personal coming out story in hopes of getting the message across to others, and to further propagate the amazing "It gets better" project started by Dan Savage and his husband Terry.

It gets better was started in response to the recent media coverage of a string of gay youth committing suicide across the country. In quoting Jay Michaelson, executive director of Nehirim, "I’m writing to you this month in the wake of six gay-related teen suicides reported in one week. At such times, all of us who are LGBT or allies ask ourselves what we can do... let’s remember that last week was not an epidemic of gay teen suicide. What was new was not the number of suicides, but the way they were reported in national media. Those of us who have been active in the LGBT struggle for equality knows that gay teens kill themselves every week, all over the country. Studies tell us that 42% of GLBT youth have suicidal thoughts, and that GLBT youth are nearly four times more likely to attempt suicide than straight ones." He's right, though some data states gay youth are actually up to 6 times more likely to attempt suicide.

Additionally, an article was printed in the New York Times this week regarding the disturbing realities of medical student/doctor suicides. The article, written by Pauline Chen M.D., stated that "...the culture of medical school makes these students also feel like they can't be vulnerable or less than perfect." These events and articles have acutely reminded me of my own past and have made me feel incredibly vulnerable. The more I think about it, I realize that I don't share my coming out story anymore because of the shame I carry with it, and because of fear of appearing "less than perfect." But by not sharing my story, a story that is way too common amongst the queer youth that I know (and don't know), I am further propagating the shame and guilt. My silence is not helping anyone; it is not raising awareness or helping queer youth feel less isolated; it is not acknowledging that medical professionals have past (and current) mental health struggles nor bring light to the copious resources to help one move forward; and it isn't honoring the experiences, good and bad, that have shaped me into who I currently am.

A week after my 16th birthday, just over 10 years ago, I attempted suicide. My attempt landed me in the ICU under a 72 hour hold, followed by 2 weeks in a psych hospital. This "event" (as my parents referred to it) was very much out of character for the 16 year old me. I was an honors student and athlete, I came from a close knit loving family, I was a "good girl" with a solid group of friends, I had just gotten my drivers license, etc... However, while I presented to the world as a put together young woman, I was completely shattered on the inside. At the time, I didn't have the words to explain why. I knew that the me I felt internally was not the same person as the world assumed me to be. My first attempts to rectify this discrepancy came in the form of experimentation with boys; numbing myself with the fantasies of teenage lust. These encounters only made things worse. They made me feel used and rotten, completely taken advantage of. One thing led to another and I found myself at the bottom of a dark well; there was no light to be seen and an urgent need to end the pain of brokenness. I was clearly an angsty and depressed teenager, but I had no understanding of what was causing these emotions and that it could get better. I felt that I had no where to turn and no other options to help me find myself. 10 years later I still thank G!d that my attempt failed, and that I was blessed with a second chance at life.

That summer, at a youth leadership camp for high school students, I met 3 young queer college students who were working as RAs. These women were the first queers I had (knowingly) ever met. Through getting to know them, asking questions about their lives, and shedding countless tears on their shoulders, it all began to make sense. I realized that a huge impetus for my angst was my sexual orientation, for not having an understanding of what it was or what it meant, and for having no clear vision of what it would mean for my future. I had no comprehension of a future life with a women and so feared that it would mean a life of pain and loneliness. Two pivotal things happened that summer though: I had my first girlfriend, and one of my RAs explicitly explained to me that "it will get better" in a tangible way that I could understand. She also exposed me to resources so that I could proactively make it better. Thank G!d for that summer. I came home and began to come out to close friends, followed by coming out to my therapist. Some were easier than others, but with each encounter I began to feel a little less shattered.

It wasn't always easy. I was outed to my parents by my therapist, without my consent. I was physically threatened by a group of boys in high school and harassed by others. I was told time and time again that coming out to my extended family wasn't an option. I feared holding hands with a lover publicly and had to seek out communities that were safe to be out in. I dealt with crushes on straight girls and learned to navigate finding other queer women to date. I shaved my head and wore combat boots in order to convince others that I was in fact queer, because it turned out simply dating women wasn't enough (and looked really stupid while doing it). I experimented with gender and challenged the notion of binary. Time and time again I ran up against my parents who's theory has always been to not show weakness, stand out, or make yourself vulnerable; and who were convinced that "it was just a phase". But, over time, it did get better in a lot of ways; which became especially true after my freshman year of college. By that time I had developed my own identity and a close group of friends to support me and as time went by, the wounds became less raw. For the first time in my life, at 24, living in a city that I love, surrounded by a family that I choose, personally accepting and encouraging my constantly evolving identity, and dating other good Jewish girls with strong queer identities: I felt like I was being true to myself, coming into my own, and paving my own path to change the world.

However, everything turned on its head with the start of med school last year. Moving south, putting myself into this ideal world of perfect superhero doctors, and living so far away from so many that I love reverted me to my 16 year old self. More often than not, I felt totally alone, raw, and vulnerable. Regardless of the soapbox I stood on, being somewhat fem and very Jewish, I was invisible queer. I lacked community and people to turn to. I had no shoulders to cry on, people to hug or cuddle with, friends within the same zip code to kick me in the butt. Once again though, it is slowly getting better. I am working on creating community here, getting better at asking friends (near and far) for the things I need, and working to make changes in myself and in the system that I can be proud of. While it is not yet totally better, I have faith that it will continue to get better as well as a shifting understanding of what better even means; and I continue to be grateful every day for the second chance I was given.

p.s. If you are an LGBTQ youth struggling about your identity, know that there are so many people out here who care about you. Also, know about The Trevor Project. Even if you don't believe me right now, your life is valuable enough to warrant reaching out to them, I promise.

Insulin is my friend, but not a cure

I've been forwarded a few articles on diabetes in the past few days. There was a feature in the New York Times on the discovery of Insulin. If you don't know the history of how insulin was discovered, you should learn! It is considered to be one of the great advancements in medicine and is a fascinating adventure of making of what was perceived to be impossible into reality. It is a story of resurrecting the (nearly) dead. In all fairness, part of my fascination may come from the fact that Insulin keeps me alive on a daily basis; but still, it is a pretty cool page in the history of scientific advancement. It won a Nobel prize. This article is a good place to start learning. This book is an even better resource to learn from. The article was published because of a new exhibit opening in New York on the history of diabetes. I want to go! If anyone is in NY and goes, let me know how it is!

Another article was on an innovative design contest held at Harvard. It makes me happy to know that "out of the box" thinking is being publicly funded and gaining growing attention. As a child, I use to constantly doodle up plans for diabetes management improvement and far fetched ideas for ways to cure it. In college, by attending an extremely progressive and integrative institution, I learned that inter-disciplinary approaches of critical analysis give rise to true innovation. I have to believe it is competition like the one in this article and the DiabetesMine annual contest will continue to revolutionize management of the disease. It is important to remember that while we have come so far with diabetes treatment in such a short period of time, insulin is not a cure.

Forgivness

So this essay kind of sucks. The month of (Jewish) holidays which just ended means that everything I've been doing has been somewhat half-assed. However, I still thought I'd post my second personal development essay of the year:

Being an observant Jew, my religious doctrine requires that I take an annual visit to the land of forgiveness. Our rabbi’s suggest that we spend the month before Rosh Hashanah preparing to ask for forgiveness from our peers, and then actually engage in the process during the10 days between Rosh Hashanah and Yom Kippur. After weeks of thinking about and asking from forgiveness from others, Yom Kippur, the day of repentance, is spent in synagogue asking for forgiveness from God. Having engaged in this religious practice since the age of 13, I have grown familiar with asking for forgiveness from peers.

The same Jewish doctrine requires that if you are not forgiven the first time you ask, you must ask for forgiveness twice more before you are let off the hook. This illuminates two different points about the process. The first that it is important to sincerely ask for forgiveness sincerely, and with enough to commitment to give your peer time to actually forgive you. Secondly, it is the others person obligation to forgive you. A process that is not always quick and easy. Though even if they don’t, you are still eventually able to move on with your life.

My actions that require asking and giving forgiveness have matured as I have aged. Actions of talking back to my parents and hitting my brother have evolved into spiteful break-ups with significant others and prioritizing myself before my family. While maturation is a good thing, the increased stakes of life’s decisions means that there is more room to seriously hurt people and to hold grudges. Misjudged actions now seem to have more significant consequences. I also realize how cathartic the process is. Holding grudges is never healthy and tends to drag me down emotionally. It prevents me from fully moving forward from the actions of my past and from becoming a better and more mature person.

One of the areas of forgiveness that I have yet to acknowledge in my life is forgiving myself. It used to be that I could use my past mistakes and self-frustrations as motivation to push forward. However, the longer that I hold onto these past experiences and negative memories, the more they weigh on my sense of self. As I am growing older, I realize that holding onto mistakes that I have made previously is airing more on destructive than productive. These memories can help fuel the fire of self-criticism. I am now realizing that I need to learn how to forgive myself, and embrace my past mistakes, through concentrating on the personal growth they have catalyzed.

The other area that I need to work on, or at least start to consider, is forgiving the mistakes of my classmates. Over the past year I have realized that I hold myself, and my classmates, to a very high standard. While we are full time students, we are also already out in the world playing doctor and interactive with many members of the community. As such I expect us to present ourselves as professionals. When a classmate does something that presents them self as less than professional, whether it be disrespecting a professor, blowing off a service learning commitment, or getting drunk and proudly posting pictures of the experience on facebook, I loose respect. These are grudges and opinions that for better or worse, I hold onto. I am just starting to realize how much I (internally) criticize such behavior. While it motivates me to present myself in a different manner, it also requires a lot of energy. I am starting to consider what I should do about these emotions and how to forgive behavior that I don’t really have a right to judge in the first place. Maybe it needs a mixture of forgiving their behavior and forgiving my own judgment.